Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child

Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.